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Suicide and our teens

Suicide and sexuality, Dec. 4

Sat., Dec. 10, 2011

Re: Suicide and sexuality, Dec. 4

Antonia Zerbisias’ article is worthwhile, just like the “it gets better” campaign has a place, along with its little known counterpart “it doesn’t get better.” These are all attempts to help queer kids cope with the difficulties they might face from being queer, and to raise awareness to a larger body of people — to say that queer youth need our support.

But with all the widely published stats about queer youth suicide, and the videos and the anti-bullying campaigns, we’re missing out on a very important group —the queer youth who are not suicidal; those who are not bullied, or cope with bullying in a way that allows them to hold on to feelings of hope.

Mental health problems have almost become the primary characteristic of queer youth, shifting the focus entirely off of sexual desire or affect. We have narrowed the number of sufficiently “queer” subject positions available to youth desiring and practicing non-hetero sexualities.

It would be really nice to open the paper next weekend to a story of a queer kid with average grades, a couple of decent friends, some conflicts with his siblings over video games and a passion for chunky peanut butter.

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Karen Kugelmass, Toronto

Re: Chasing down demons, Dec. 3

Thanks for the excellent series of articles on youth suicide last weekend. Two points of clarification regarding Paul Hunter’s feature in which he refers to “Tourette’s syndrome and other mental disorders.”

First, the disorder is properly called Tourette Syndrome — Gilles de la Tourette, who first identified it, didn’t have it himself so the word isn’t possessive.

Second, while the challenges of living with physical and verbal tics, twitches and outbursts may contribute to mental health issues such as depression, Tourette Syndrome is a neurological disorder.

Mental illness is emotionally, behaviorally or psychologically based and often treatable or curable. A neurological disorder is one of the brain, spine or nervous system: we don’t characterize Parkinson’s, Alzheimer’s or other such diseases as mental health issues, and neither is Tourette.

Some treatment is available, but there is no medication specifically for Tourette, and no cure: understanding and support are crucial to those who live with this disorder.

As suicide continues to affect people across the country, it is admirable that the Star is addressing the topic. However, in their zeal to raise awareness, what media often miss is that extensive and emphatic coverage of suicide can be counter-productive. We view your recent series as an opportunity to open a real dialogue with Canadian media about how we can work together to prevent suicide and promote the well-being of youth.

As you suggest, even one suicide is too many — a tragedy that is compounded by the myriad and intricate forces that contribute to suicide. Ninety per cent of suicides occur among people who have diagnosable mental health struggles — complex conditions that are affected by biological, emotional, and social factors.

The onset for most clinical mental health struggles is age 15-20. Unfortunately, these struggles are exacerbated by stress, also prevalent during these years. Academic pressure, leaving home to attend a post-secondary institution or live independently, and yes, bullying — homophobic or otherwise — are all stressful life events that can trigger youth who are already at risk for suicide.

Social inequity also plays a strong role. Globally, suicide is highest among low-income people in developed countries with high GDPs. In Canada, suicide is nine times higher among First Nations youth than among non-First Nations youth, and LGBTQ young people are also at a greater risk.

As there is rarely one cause of suicide, there is no simple way to prevent it. We are heartened that the province is developing a suicide prevention strategy which, to be effective, will require the participation of policy makers, health care and service providers, parents, educators and young people themselves to improve resources, reduce stigma and encourage help-seeking and help-giving behaviour.

The press plays a tremendous role in this process. Amazingly, there is one reporting method that has been shown to have a dramatic and immediate reductive effect on suicide. In the mid-1980s, major media in Austria reduced press coverage of suicides, and engaged in “safe reporting” when coverage was unavoidable. Within five years of implementing these guidelines, the number of Austrians who died by suicide dropped significantly.

What the Austrian example teaches us is that, counter-intuitively, suicide is not a mental health problem that benefits from all forms of awareness. Rather, frequent and irresponsible media reporting on suicide appears to be linked to rising suicide rates.

To ensure that media avoid counter-productive coverage, major health agencies worldwide, including the Canadian Psychiatric Association, regularly release guidelines for media. They recommend press reduce suicide reporting overall; exclude information on suicide methods; avoid implying that suicide is “caused” by any single factor or event (such as bullying), and keep the word “suicide” out of headlines.

Parts of the Star’s teen suicide series, while undertaken with the best of intentions, had the unfortunate effect of sensationalizing the issue by reporting details of suicide attempts, as well as enforcing stigma through the repeated use of the term “committed suicide” (suggestive as it is of a crime). We should also consider that the use of “suicide” in multiple headlines and large-sized font could be triggering for readers who are currently struggling.

Kids Help Phone will continue to work with media to ensure that coverage of youth mental health and suicide is sensitive, accurate, and helpful. We encourage press not only to implement and enforce safe reporting guidelines around suicide, but also to report on health and social issues that affect young people — before deaths have occurred.

As a major daily newspaper with a large circulation, the Star has a great impact on public opinion. It can use this tremendous power to advocate for young people’s mental well-being by supporting health care, early childhood education, and effective anti-bullying interventions, by advocating for First Nations and LGBTQ youth, and by taking a stand against the poverty, unemployment, and inequity that limit young people’s futures.

This way, as thousands across Canada continue to struggle with thoughts of suicide, the Star can be leaders in responsible reporting on suicide and part of the solution.

We would like others, including those involved in mental health care, to learn from our older daughter’s in-patient suicide. But they won’t. Why not? Because the most complete and timely review of our daughter’s suicide on the grounds of a mental health and addiction facility is protected by legalized secrecy and lawyers who are more interested in protecting the reputations of their clients than improving mental health care.

That review, conduct by the mental health facility, included an analysis of our daughter’s medical records and input from the staff involved with her care. Other reviews by an independent forensic psychiatrist, a patient safety review committee and the regional coroner were limited to the medical record. Staff who observed and treated our daughter on a daily basis were not consulted. The bottom line is that the most thorough review of our daughter’s suicide will languish in the institution’s archives. Lessons that could be shared to help avoid similar tragedies are lost.

We asked for a coroner’s inquest into our daughter’s suicide but were denied because the coroner’s office is not legally required to hold inquests into in-patient suicides and because the cost is high. As a family, we appreciate the limitations under which the coroner’s office works. Changing the law to require the coroner’s office to conduct inquests into in-patient suicides would help ensure best practices are used in the treatment of suicidal patients.

When we filed a complaint with the College of Physicians and Surgeons, the college attempted to boil down our complaint to three concerns. We wrote back listing 14 concerns, many supported by mental health professionals. Despite this evidence, the CPSO concluded the care our daughter received before she completed suicide while an inpatient was “satisfactory in every regard.” We later learned that CPSO felt no obligation to consider the opinions and conclusions of mental health professionals who had reviewed our daughter’s medical records. Professional groups such as the CPSO should be opening up and encouraging discussion of mental health care, not shutting it down.

Not knowing more about our daughter’s final days and hours is hard to live with. Knowing lessons that could be used to help other families have been lost is discouraging. Mentally ill patients and their families deserve better.

Ross Irvine, Guelph

I think in general there is an increase in depression and suicide in our society because we have lost the sense of “being human” and human suffering. Your article “Sweetie, pups join Canadian family” is proof of this lost.

It puzzles me how a woman can be so traumatized by the “suffering” of some animals, and not be equally traumatized to visit her heritage country to find hungry children running around the streets of India with no shoes. Perhaps she was sadden to see the poverty, but what did she do to help some of the poor people there?

I used to be afraid of dogs, until I went to Honduras this fall. In Canada, I used to be afraid of dogs because they would start barking and jumping on you, if you are a stranger to them. In Honduras, the dogs are too weak and malnourished to go chasing after strangers. So, they just ignore you when you pass by.

Unlike the dogs, the poor, undernourished children of Honduras were full of energy and enthusiasm to strangers. I was overwhelmed by their affection! In Canada, if I a give a hug a kid, I risk being arrested for “child” abuse. In Honduras, I just have to say “hola!” and I get a big affectionate hug from a kid.

In a poor society, people still believe in a God, who is their father and provider, so they live total abandonment and they thank God for everything. They always happy and grateful for everything. In our rich country, we live in abundance, so we blame God for everything. We have replaced God with our material wealth such that it becomes our saviour to all our problems.

It is very hard for our society to accept depression as an illness because “we have everything we could possibly need, so why be depressed?” Our materialistic society has brainwashed our minds to equate material wealth and independence to happiness and freedom. Then why are we so depressed? The truth is happiness comes from a reciprocal relationship. To love and be loved. That is man’s necessity. One can love his iPod and cellphone, until one day he discovers that he is not going to get back that same affection from the cellphone. Then what happens?

We spend so much time with material needs and wants that we lose sight of the human needs of ourselves and others. We don’t know how to relate to each other as human beings, with love, care and affection, because we are better at relating to our computer — speed, accuracy and efficiency. We then cannot tolerate to see defects in ourselves and our fellow human beings, because we expect them to be like our best friend, the iPad.

So, if we don’t know how to love our neighbour, and our iPad doesn’t love us, where do we turn to? Our pets. They are warm and cuddly to have, and they don’t expect us to be their iPad, like our friends do.

In our society today, it is safer and more cool to love our pet animals, than to show compassion our fellow human beings. It is no wonder that there is an increase in depression.

Lin Choo, Mississauga

I would like to sincerely thank the Star for the numerous articles on suicide prevention and awareness. If these informative pieces had been written when my son began to show signs of depression and mental illness, perhaps we would have recognized those signs and been able to get him the much needed care sooner. Perhaps we would not have lost him three years ago.

I would, however, ask that instead of referring to a person who dies from suicide as having “committed” suicide. A better phrase would be “died from” or “as a result of.” It is not as if those who die from suicide know that they have any other option at the time; they have not “committed” anything.

It is very painful for those left with the loss of a loved one to read or hear “committed.” Suicide and depression are health issues, not an action that is a choice.

Carol Krafft, Barrie

The Star’s excellent series on teen suicides observes that the transition from high school to university is very difficult. Yet flat-fee tuition policies, variations of which have recently been enacted at several Ontario universities, unfortunately increase the stress on families and the associated risk of student suicide.

The more familiar “pay-as-you-go” system allows students to reduce the course-load along with the fees, which is especially important considering the massive inflation of tuition over the last two decades.

When it was originally proposed at the University of Toronto, the flat fee was estimated to increase revenue by $10 million and help to repair “a business model that is quite frankly broken,” according to the dean.

Clearly, a growing number of students are also “broken,” and it should not be forgotten that suicides also result in massive costs not only for families but for society — something that policy planners should consider when they deploy business-style planning in universities and other public institutions.

It is ironic that the “business-model” planning of public finance has resulted in greater collectivization of fees at university, as the model usually entails higher individual user fees, such as in private health services and toll roads.

Your series provides ample reason for the highest levels of government to reconsider whether its fiscal policies serve the best interest of youth, who represent the future for all of us.

Taylor Roberts, Toronto

In your series on teen suicide there was no mention of the obvious. It is primarily a male act, when carried out to its intended conclusion. I am a depression survivor (innocently precipitated by doctor-prescribed medication) who lost both a brother and an uncle to suicide. Young males must be valued and identified by society as just as vulnerable and valuable as their female counterparts, and encouraged to be in touch with and not afraid to talk about feelings, fear, inadequacy, etc. Public discussion must become the norm of what is a primary male act. Until then, we can all look forward to yearly special inserts about teen suicide that are meaningless unless the gender component is acknowledged.

Richard Adams, Port Elgin

There are many reasons why Mitchell Pham’s choice is close to my heart. One is that I could have known him. Mitchell and I were a person apart from each other, through his cousin. I watched her when she came back to school a week after the news came, a week that she used to attempt to compose herself and make it seem as if she wasn’t dying inside. But she was.

She was an amazing actress, but it does not change the fact that anyone could see that the loss of such a close, important person in her life was so shattering. Even now, over a month later, I know that deep down it’s always on her mind, always tormenting her.

Then there is the fact that someone so bright, so ready for success, was unable to reach it. We look at Mitchell, and we can see someone who would be able to change the world someday. But he didn’t, and we have to ask ourselves why he couldn’t have. Why he was forced to make such a decision.

I am a year younger than Mitchell. In a year I will be in the position that he was in — getting prepared for university, wondering what I’m going to do in my life. I’m not going to say that my stresses are as heavy as his were, because they aren’t. I am nowhere as bright as he was, and my future will be nothing as brilliant as his should have been.

But even I, as can hundreds of thousands of children in North America and the world, know exactly what was going on his mind at one level. Adults might see this in hindsight, or maybe they never felt this at all, but when you reach our age there is a terrifying moment of nothingness. A moment of feeling that everything; all the stress, all the time that you once got to use doing the things you love, all the preparation; that it is not going to add up to anything at all. That even if you work harder than you ever have in your life, you will not reach your goal. You look past graduation of high school, and there is a void. Then, even if you do go into university, there still is that void of endless uncertainty.

I can’t say I haven’t considered chickening out and not waiting till then. I can’t say that I share the exact feelings that Mitchell felt when he made that choice. But I know what it is like to give up. Teachers and parents, you try to make it seem like something it isn’t. But it is. There is so much stress placed on us at this time period, and its spreading to younger ages all the time.

We have more work than we can do at a time, more decisions that we have to make without being given a chance to think about it. We don’t have time to sleep, we can’t relax for a few minutes. Even if we do, chances are there is someone there telling us we need to do something to contribute to society, to our futures. But with all that stress, there may not even be a future.

I’m scared. My friends are scared. Your kids are scared. They just might not tell it to you. Telling them to shut up and work harder doesn’t help at all. We suck it up and go on, and it builds and builds and builds until we’re ready to explode. We scream at you, or we go silent, but it’s all the same in the end if you don’t realize that we’re dying inside.

When I was told that my friend’s cousin died, something inside of me stopped. Suicide was something I hadn’t realized I had brushed closely before to. I don’t mean that it was the first time I had felt it, but it was the first time I realized what it was. There is not a single teen in your life that you will meet that has not thought of ending it, of giving up.

Let it be because of a feeling of loneliness, or of hopelessness. It might be a fleeting thought, like it is for many, or a constant deliberation that still is on their minds, like has been for me for years. But they can all end up in the same place as Mitchell.

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